Physiotherapy, including relaxation, manipulation and exercise is part of the normal Stroke rehabilitation process. Repetitive exercises, undertaken by the stroke sufferer, focused on the parts of the body where movement has been reduced by stroke, helps to re-establish movement. This is achieved because neuroplasticity allows brain functions, which support physical body movements damaged by stroke, to be taken over by undamaged parts of the brain and become re-established.
One of the difficulties encountered by stroke sufferers as they try to recover, is the number of repetitions of specific exercises required to re-establish movement. Thousands of repetitions are required over months or years and even then progress can be slow. The sufferer has to be VERY highly motivated, over a long period of time, to carry out the large number of repetitions required. Motivation or the lack of it can have a very significant impact on recovery. The sufferer will, no doubt, go through the exercises with the physiotherapist. However, to achieve even a moderate improvement exercises need to be carried out alone, in the correct manner without supervision, for long periods each day.
In Hypnotherapy the therapist suggests new, positive behaviours to the client while in hypnosis. For example, suggestions made to a weight loss client would include: “From today, you eat small portions of healthy nutritious food”. These suggestions are made directly to the subconscious mind in hypnosis and because the subconscious is non-judgemental (unlike the conscious mind) they are adopted and support new changed behaviours. Many suggestions are characterised by visualisation. For example, “Imagine that you are watching a video, on a big bright TV screen right in front of you. And in the video you see yourself walking, helped by your physiotherapist Carol. You are walking tall looking straight ahead, looking strong and confident”. So these positive helpful suggestions are taken on board by the subconscious and become habitual. When this happens new neural pathways are established in the brain to support these behaviours and old pathways supporting bad behaviours waste away. So hypnotherapy uses neuroplasticity to great effect, often changing the habits of a lifetime (smoking) in one short therapy session.
Visualization for improved performance
Visualization has been used in Sports Science for decades. Seasoned athletes use vivid, highly detailed internal images and run-throughs of the entire performance, engaging all their senses in their mental rehearsal, and they combine their knowledge of the sports venue with mental rehearsal. World Champion Golfer, Jack Nicklaus has said: “I never hit a shot, not even in practice, without having a very sharp in-focus picture of it in my head”.
A study looking at brain patterns in weightlifters found that the patterns activated when a weightlifter lifted hundreds of pounds were similarly activated when they only imagined lifting.
Brain studies now reveal that thoughts produce the same mental instructions as actions. Mental imagery impacts many cognitive processes in the brain: motor control, attention, perception, planning, and memory. So the brain is getting trained for actual performance during visualization. It’s been found that mental practices can enhance motivation, increase confidence and improve motor performance.
Focus on Quality
As discussed above, the stroke sufferer in recovery must perform a very high number of repetitions of specific exercises, on their own, to achieve success. Motivation may be high to begin with, but tapers off rapidly and the required number of repetitions is only likely to be achieved in a limited number of cases. This places a practical limit on what can be achieved via Physiotherapy. If quantity of exercise required is very hard or impossible to achieve, then improvement in quality of exercises undertaken might be a way of improving outcomes. There is plenty of evidence to show that visualisation improves outcomes in sport. In fact many top sportsmen and women have used the enhanced levels of visualisation enabled by hypnosis to improve their performance. Top sports people talk about being “in the zone” and totally focussed. This is similar to being in a state of hypnosis.
When stroke sufferers are taken through a set of steps, for example the transfer from wheelchair to car in hypnosis. They are, of course, visualising the steps involved guided by the therapist. Subsequent performance of the task appears significantly improved. The same can be said of specific exercises, when these are undertaken in hypnosis with the use of strong imagery, provided by the therapist. For example, an arm stretching exercise where the fingers of both hands are interlocked and then the arms stretch forward together. This involves visualisation of the whole arm, right from the shoulder blade down through all the bones and muscles in the arm right down to the palms of the hands, before the exercise even begins. The exercise itself, in hypnosis, involves visualisation of the whole movement, including breathing. The result is an exercise well executed. In fact the range of movement in hypnosis often exceeds the range of movement achieved normally. So hypnosis evidently provides an increase in the quality of movement while at the same time using neuroplasticity to establish that movement or set of tasks in an unaffected part of the brain.
Physiotherapy, aided by neuroplasticity, plays a major part in stroke recovery. However, unless levels of motivation in the stroke sufferer are exceptionally high, recovery of movement is limited. Visualization used in hypnosis appears to improve the performance of sequential tasks and individual exercises. It too relies on neuroplasticity. This being the case, the limitations imposed on the Physiotherapy by the sheer number of repetitions required, could be overcome by the use of visualization, in hypnosis, where the the exercise is performed is to a higher quality and the visualization involved better and perhaps more rapidly exploits neuroplasticity.